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Mental health and substance use disorders are the leading cause of disease burden in the United States. With 10.1 deaths due to mental health or substance abuse disorders occurring per 100,000 people, the U.S. has the highest mortality rate for these disorders among similarly wealthy countries, which see an average 4.4 deaths per 100,000 people. In our latest chart collection, we explore the prevalence, outcomes, access to care, and costs of mental health disorders and substance abuse in the U.S.

The Substance Abuse and Mental Health Services Administration (SAMHSA) gathers substantive estimates of the prevalence of mental health disorders and drug use among adults and children in the U.S. via its annual National Survey on Drug Use and Health (NSDUH). In 2014, the NSDUH found that 43.6 million (18.1%) adults in the United States had any mental illness within the year, a prevalence that has remained relatively the same since 2008 and has consistently been highest among adults ages 26 to 49. Almost 10 million adults (4.1% of all adults) reported having a serious mental illness – that is, one which impairs functioning enough to affect major life activities.

According to data from the CDC National Health and Nutrition Examination Survey, 13% of children ages 8 to 15 had a diagnosable mental disorder within the year. Attention deficit hyperactivity disorder (ADHD) is the most prevalent mental health disorder among children in this age range (8.6%), followed by mood disorders (3.7%) and major depression (2.7%).

When surveyed in 2014, 8.1% of people age 12 or older reported having a substance use disorder within the year. Of those, 80% reported having an alcohol use disorder, 33% reported an illicit drug use disorder, 20% reported a marijuana use disorder, and 9% reported a pain reliever use disorder.

The latest government data show that deaths due to prescription opioid painkillers were 3.4 times higher in 2014 than they were 2001. The 2014 NSDUH found that at the time they were surveyed, 4.3 million Americans reported non-medical use of prescription painkillers within the month, and 1.9 million met the criteria for prescription painkiller addiction. An April 2016 Kaiser Family Foundation Tracking Poll found that 44% of Americans say they personally know someone who has been addicted to prescription painkillers.

In addition, a recent CDC report indicates that the U.S. suicide rate reached 13 per 100,000 people in 2014 – the highest it has been since 1986. The report finds that after almost steadily declining between 1986 and 1999, the national suicide rate increased a startling 24% between 1999 and 2014, with a 2% increase per year beginning in 2006.

There is no recent available data about the prevalence of mental health and substance use disorders among homeless and institutionalized populations. However, a 2010 point-in-time study by the U.S. Department of Housing and Urban Development found that 26% of adults living in homeless shelters had a serious mental illness, while 35% faced substance abuse, resulting in an estimated 46% of homeless adults in shelters facing either mental illness or substance abuse, or both. The most recent available data on mental and behavioral health among inmates come from Department of Justice surveys conducted at state and federal prisons in 2004 and local jails in 2002. The surveys found that over half of prisoners in both state prisons (56%) and local jails (64%) reported heaving a mental health problem within the year, as well as 45% of prisoners in federal prisons.

Mental health and substance abuse treatment most often occurs on an outpatient basis – either as outpatient treatment, prescription drugs, or a combination of both. When inpatient treatment occurs, it is mostly for schizophrenia and mood disorders, such as major depression and bipolar disorder. Use of mental health services is reportedly similar among Whites, American Indian and Alaska Natives, and those of mixed race, with about 16% to 17% percent of each group reporting any use of mental health services. Utilization is lower among Blacks (9%) and Hispanics (7%), and lowest among Asians (5%).

In 2012, non-institutionalized spending on mental illness amounted to $80 billion, according to data from the Bureau of Economic Analysis’s Health Care Satellite Account – meanwhile, spending on circulatory diseases, the second leading cause of disease burden, amounted to $247 billion. Historically, the cost of treating mental illness has grown relatively slowly compared to other disease categories (the price index for this mental illness treatment grew at an average annual growth rate of 3.1% from 2000 to 2012, compared to an average of 4.4% across all disease categories). Yet spending changes indicate that the number of treated mental illness cases grew at an average annual growth rate of only 2.8% from 2000-2012. An estimated 30% of adults with major depression did not receive care in 2008. In 2014, almost 30% of those with a serious mental illness did not receive care. About 30% of people age 12 and older with a need for illicit drug use treatment received care, while 15% in need of treatment for alcohol use received substance use treatment.

Discussion

There is a complex interplay between mental and behavioral health problems and medical and socioeconomic problems (such as chronic diseases, poverty, and crime). Comorbidities are common, and one problem often causes or aggravates another, and vice versa. Various government agencies are developing models to integrate behavioral health care and medical care, in part to address this cycle. Currently, behavioral health care services are fragmented, varying by service type, population served (i.e. insured, uninsured, homeless, institutionalized), and the institution providing care (i.e. hospitals, private practices, community health centers, prisons, etc.). Funding for these services is thus fractured as well, coming from a variety of payers (including states, counties, the federal-state Medicaid program, federal Medicare, and other public as well as private programs).

This all makes mental health reform a challenging undertaking. In light of what the CDC has deemed epidemic levels of prescription opioid overdose and addiction, policymakers and providers are now addressing a need for reform with regards to prescription drugs and opioid use. President Obama recently announced the establishment of the Mental Health and Substance use Disorder Parity Task Force, and the CDC itself released primary care guidelines for the first time, outlining the prescription of painkillers for adults. Various pieces of legislation have also arisen in response to growing concern over the prevalence of prescription painkiller abuse and addiction. The U.S. Senate Health Committee has passed a bill on drug treatment and prevention, and many separate bills specifically addressing opioid abuse or prescription are currently pending before the Senate HELP Committee. The Committee is also at work on The Mental Health Reform Act of 2015, which would in part create a federal assistant secretary for mental health and substance abuse, extend certain mental health programs, and expand mental health coverage and training. These bills are expected to reach the full Senate later this year. Mental health and substance abuse legislation is also circulating in several state legislatures, including Connecticut, Colorado, Maryland, and California.

Considering the variety of services and institutions involved in providing treatment for mental health and substance abuse disorders, efforts to understand the effects of broad mental health and substance abuse reform are limited by the lack of recent data about the prevalence of specific disorders and the severity of these problems among some of the most at-risk populations.

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